Case study and physical exam are crucial to a proper diagnosis

Case History: This is one of the most important steps of assessing the patient.

A thorough case history will assist in determining the diagnosis of the patient.

The important information is:

  • Onset of symptoms: spontaneous, head or visual motion provoked
  • Temporal course: Is dizziness intermittent or continuous? Does it last seconds, minutes, hours, days or weeks?
  • Type of dizziness: objects in room spinning, feeling of spinning in the head, imbalance, light headedness, disorientation, falls, unsteadiness
  • Does the patient have signs of a central disorder (e.g. double vision, dysarthria, disturbances of sensation)?
  • Other symptoms: nausea, vomiting, headaches, motion sickness, intolerance of light, oscillopsia, heart palpitations, feeling of panic, drop attacks
  • Hearing: aural fullness, tinnitus (low or high frequency), progressive loss of hearing, fluctuating hearing loss, sensitive to noise, intolerance of sound
  • Past medical history: head trauma, back surgery, ototoxic drugs (e.g. gentamicin), diabetes, perilymphatic fistula

 Note: It is necessary to rule out central causes of dizziness (e.g. stroke, traumatic brain injury, cardiovascular disease,
neurological disorders (Multiple Sclerosis), anxiety, and side effects from medications or street drugs.)


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